Subjunctive Complaints

Let me start by saying this isn’t a cry for help.

Physician burnout has been getting some press lately. Physician satisfaction, or the lack thereof, a bit less so, but it’s at least present. A few years ago, there were more articles supporting the high risk (if not prevalence) of more serious psychiatric disorders among physicians, with results similar to those we’re finding in the satisfaction and burnout studies: that certain specialties are more strongly associated with problems, that pay matters a little but not as much as one might think, and that they’re major problems that certainly need to be addressed.

Not that anyone has come up with a way to address them; no matter how many studies demonstrate problems with job satisfaction or burnout, it’s difficult for most people to see these as problems that need to be fixed. Physician satisfaction sounds ridiculous, because of course physicians love medicine, have the jobs they’ve dreamt of their entire lives, and get paid massive sums to do work that mainly involves either standing, sitting, or walking and isn’t particularly dangerous. Physician burnout is perhaps a bit more of a “real” issue, as it’s at least understandable that doctors would become frequently stressed (or at least “fatigued”) from 12- to 16-hour days working with patients on issues that are literally matters of life and death.

And psychiatric disorders? We don’t talk about them. We can’t talk about them. We won’t even call them “diseases”, though it’s plain that they are; we simply classify them as “disorders” instead, downplaying the obvious chemical abnormalities and diagnostic testing that’s at least as clear as that of, say, acalculous cholecystitis, and really quite analogous to the “choose any four” criteria from the lupus playbook. Mood disorders, anxiety disorders, substance use disorders, they all have diagnostic markers of one form or another (and, like most diseases, the actual sensitivity and specificity of individual markers are noted to change over time), all are associated with medications and other treatments to which they typically respond quite well, and all are quite prevalent within the general population. It’s not surprising, therefore, that they’d be prevalent in the physician population.

Except that physicians can’t talk about them. Or at least they can’t talk about having them.

If I had a cold, my coworkers would know. Even if I weren’t coughing, I’d be complaining about it constantly, whining even. I’d look bad (well, worse) to the most untrained eye, and a particularly sympathetic colleague might offer me antibiotics. (We are surgeons, after all; if we can’t cut it out, perhaps antibiotics will work.)

If I had GERD while too busy to see my PCP, someone in my department might refill my PPI; most wouldn’t even blink. Of course I have GERD. Who doesn’t?

If I had cancer, I could tell my partners, my chairman, my division chief. They’d make sure I had everything I need. They’d ask which surgeon was going to operate, which oncologist I’d be seeing. They’d check in with me to see what my latest MRI showed, what the path result was. They’d find when I was getting my next follow-up scan and ask about it afterwards.

If I were depressed, I couldn’t tell anyone. Far more likely than even becoming the surgeon with cancer, I’d be the surgeon with depression. My coworkers wouldn’t know what to say to me. My partners wouldn’t check in, they’d avoid the subject and hope I was in a “good mood”. My division chief would wonder if hiring me was a good idea, or if perhaps that’s why my productivity was down. My chairman would consider the possibility of a malpractice lawyer or journalist finding out that there was a “mentally ill” surgeon operating regularly in the dead of night.

No, I don’t know any of this. I’ve got awesome colleagues, and it’s entirely possible that my awesome colleagues would be the exceptions, that my partners, my chief, and my chair would demonstrate ably how they’re even more outstanding physicians than most, that they’re interested in treating medical problems of all sorts among their staff. However, for many physicians these possibilities are far too unlikely to risk. We pride ourselves on understanding disease better than anyone in history, but have visceral reactions to psychiatric disease that rival those of our ancestors from the middle ages. We recognize that the physician is Everyman rather than Superman, but don’t accept certain flaws within him. We encourage our students and trainees to be wary of burnout, of depression, of suicidality—but we don’t expect it (or perhaps willfully ignore it) in our coworkers. An entirely unknown segment of medical providers are entirely unable to get treatment for some of their own medical problems.

No, I haven’t come up with any way to address these issues, either. If there’s a doctor out there with a psychiatric disease, a doctor who’s burned out, a doctor who’s not taking care of patients the way he’d like, I don’t have a therapy that’s proven to work or even a study in which he can enroll. If there’s a surgeon in practice who’s having difficulty getting out of bed and coming to work because she’s depressed, or hung over, I don’t know the best way for her to get help. I do know, however, that if any of these physicians were to discuss their issues with me, I’d listen, I’d respect them for reaching out, and I’d do everything I could to get them help for their illness, which would likely involve talking to a lot more people. I’d recognize that their disease was no less worthy of care than that of the physician who asks me for a prescription antibiotic for their bronchitis or the surgeon who needs a hernia repaired. I’d know that doctors get sick, too, and that for some diseases the opportunity to simply state their presence is an all-too-unavailable option for many in health care, and one that is sorely needed before any treatment can begin.

If someone comes to you needing help, be there for them. If you need help, there will be someone there for you.